mHealth use intensity and nurses' moral distress: The mediating role of perceived technical barriers to caring

BackgroundMobile health (mHealth) technologies have become increasingly integrated into nurses' workflows, enhancing efficiency while potentially disrupting the relational aspects of care. However, empirical evidence remains limited regarding how high-intensity mHealth use is associated with ethical strain among nurses.ObjectivesThis study examined the association between mHealth use intensity and nurses' moral distress and whether Perceived Technical Barriers to Caring (PTBC) statistically mediated this association.Research designA cross-sectional correlational design was used. An anonymous electronic questionnaire assessed mHealth use intensity, PTBC, and moral distress. Structural equation modeling with 5000 bootstrap resamples tested the hypothesized model.Participants and research contextA total of 331 registered nurses were recruited from three public general hospitals with established mHealth systems in Guizhou Province, Southwest China, between May and October 2025.Ethical considerationsThis study was undertaken during the author's doctoral studies in Nursing at St. Paul University Philippines. In accordance with the university's research ethics requirements, the study protocol was reviewed and approved by the Research Ethics Committee of St. Paul University Philippines. The study was conducted among registered nurses in public hospitals in Guizhou Province, China, and institutional permission was obtained from the participating hospitals before data collection.ResultsThe structural model demonstrated good fit (χ² = 195.02, df = 148, χ²/df = 1.32, CFI = 0.975, TLI = 0.972, RMSEA = 0.031, SRMR = 0.051). mHealth use intensity was significantly associated with PTBC (B = 0.31, β = 0.33, p < .001), and PTBC was significantly associated with moral distress (B = 1.58, β = 0.48, p < .001). The direct path from mHealth use intensity to moral distress was not significant (B = 0.57, β = 0.18, p = .157). A significant indirect association was observed through PTBC (unstandardized B = 0.49, bias-corrected 95% CI [0.22, 0.93]; standardized β = 0.16, 95% CI [0.06, 0.25]).ConclusionsmHealth use intensity was indirectly associated with moral distress through PTBC, but no significant direct association was observed. Care-sensitive digital implementation may help reduce technology-related ethical strain.